Restrictive Practices

Restrictive practice is:

making someone do something they don’t want to do, or stopping someone doing something they want to do

However this on it’s own is not enough and needs to include:

……and making someone do something with which they comply, or appear not to object to or resist, but which still restricts or restrains them or deprives them of their liberty.

The Deprivation of Liberty Safeguards (DoLS) only used to apply to people who lack capacity if they were in a residential or hospital setting but court decisions in 2014 have extended them to cover any environment in which a person is receiving continuous supervision and control, is not fit to leave and lacks capacity to consent to it and is funded by a government agency such as social services or under health provisions.

Restraint is:

The use or threat of force to help do an act which the person resists, or the restriction of the person’s liberty of movement, whether or not they resist. Restraint may only be used where it is necessary to protect the person from harm and is proportionate to the risk of harm.” (Mental Capacity Act 2005)

Deprivation of liberty is a form of restraint and it means to prevent someone from exercising their rights and freedoms.

Any restrictive intervention must be justified both ethically and legally. It must only be:

  • Imposed if necessary to prevent serious harm
  • The least restrictive option
  • Approved using the correct authorisations

Restrictive Practices

Any form of Restraint – not only physical but also chemical e.g. via medication; psychological e.g. use of punishments or treatment which relies on denying people access to something or some experience if they do not conform

Constant and intensive supervision – one-to-one or two-by-two supervision etc. would need approving as it could be used as a way of restricting or restraining a person and a gross infringement on their liberty and right to privacy

Physical restraints – e.g. Use of straps, belts, wheelchair bars, wheelchair belts, inappropriate use of wheelchair brakes, tucking in sheets too tightly, bed rails, straightjackets, holding a person or restricting a person from moving freely, pinning them down on the floor or against a wall. Tying people to chairs, toilets, leaving people who are unable to transfer themselves in the bath, on the toilet or in need of changing for longer than they need to be there etc. Forcing someone with an amputation to use false legs when they prefer to use a wheelchair.

Medical/chemical restraint – the prescription and administration of medication which alters someone’s behaviour or responsiveness, e.g. sedatives, sleeping tablets, antipsychotics. Being forced to take medication or pressurising someone into taking it against their will if they are not under a Mental Health Act Section. Disguising medication (including grinding it up) or hiding it in food. Administering medication or a care procedure to someone when they are willing/able to do it themselves.

Prevention of someone’s free movement around their home, garden a building or a public area- e.g. use of locks on doors to deny a person entry to their rooms or exit from them, access to food etc. Use of barriers such as baby gates used for adults. Threats or punishments which deny a person something they enjoy e.g. denying access to visitors, friends or food. The use of electronic surveillance or unauthorised Telecare equipment which monitors a person’s movements about their home and environment. Forcing or pressurising someone to do daily living activities. Forcing people to go to bed or get up at a particular time. Social isolation e.g. sending someone to their room; or putting them in a quiet or padded area. Forcing or pressurising someone to do daily living activities. Refusal of funding or staff to be assisted to go out of their home and socialise. Social isolation e.g. sending someone to their room; or putting them in a quiet or padded area. Forcing someone to go out and socialise when they do no wish to do so.

Use of equipment to restrict someone’s liberty. E.g. pushing someone too close to a dining table to stop them leaving the table; using a tray on a wheelchair rather than enabling someone to sit at a table. Keeping someone in a wheelchair when they can be transferred to an ordinary chair or transferred to a vehicle without it. Compulsory use of a bib or feeding cups or other equipment like hoists and lifts when not needed (e.g. if for the convenience of staff/carer rather than for the person’s needs); forcing someone to use a wheelchair when they are willing and able to walk.

Bodily functions – forcing people to go to the toilet at a particular time or failing to assist them when they need to use it. Using incontinence pads and devices for the convenience of staff/carers if the person is able to use the toilet; denying people access to food and drink (e.g. by refusing to provide them when they need them or placing locks on cupboard, fridge or kitchen areas). Forcing someone to eat something.

Not ensuring someone’s environment is accessible, e.g. failure to enable a person to move freely in their home by deliberately keeping barriers in place, denying the person access to a lift, ramp or other adaptation which has been installed to address their impairment (including denying people with sensory impairments as well as those with physical impairments to equipment which they find useful).

  • Putting things out of a person’s reach or insisting someone else uses it
  • Privacy violations e.g. not allowing a person privacy; reading, censuring or opening their mail; other infringements or personal dignity, interference in human rights such as decisions about who to marry. Preventing a married couple from sharing a room in a residential home.

Working to the 6 C’s which are Care, Compassion, Competence, Communication, Courage and Commitment, will minimise the risk of them using restrictive practices.

Use to answer question 10.1f of the Care Certificate

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